A 28-year-old primigravida with rheumatic mitral stenosis (valve area 1.2 cm²) is at 28 weeks with New York Heart Association Class II symptoms. Her heart rate is 102 bpm. Which drug is MOST appropriate to improve maternal haemodynamics in this scenario?

• A Digoxin 0.25 mg daily for rate control
• B Diuretics to reduce preload
• C Balloon mitral valvuloplasty after 34 weeks
• D Metoprolol succinate for rate control ✓

Explanation

In mitral stenosis in pregnancy, the critical physiological derangement is tachycardia (reduced diastolic filling time worsening pulmonary congestion). Beta-blockers (metoprolol or bisoprolol) are first-line for rate control in sinus tachycardia with mitral stenosis in pregnancy. Digoxin is reserved for rate control in atrial fibrillation. Diuretics may relieve congestion but do not address the underlying haemodynamic problem. Balloon mitral valvuloplasty (Inoue technique) can be performed during pregnancy for refractory NYHA III/IV despite medical therapy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.